Oregon Health Care Reform and Medicare/Medicaid Alignment
|
|
- Jocelin Beasley
- 5 years ago
- Views:
Transcription
1 Oregon Health Care Reform and Medicare/ Alignment Kate Sharaf, Office for Oregon Health Policy and Research November 2012
2 Focus of Presentation Oregon s Health System Transformation through the Coordinated Care Model Dually Eligible Individuals and Oregon s Demonstration CMS Demonstration Rate-setting Methodology 1
3 Oregon s Health System Transformation through the Coordinated Care Model 2
4 3
5 Triple Aim: A new vision for Oregon 4
6 Coordinated Care Organizations 5
7 Expectations: CCO Criteria Coordinate physical, mental health and chemical dependency services, oral health care. Encourage prevention and health through alternative payments to providers. Engage community members/health care providers in improving health of community. Address regional, cultural, socioeconomic and racial disparities in health care. Manage financial risk, establish financial reserves, meet minimum financial requirements. Operate within a global budget. 6
8 7
9 Dually Eligible Individuals and Oregon s Demonstration 8
10 Dually Eligible Individuals in Oregon Approximately 59,000 full dually eligible individuals High managed care penetration: 47% are in managed Medicare (many in SNPs) 61% are in managed Often in the same plan for both Medicare and Approximately 24,000 (about 40%) of dually eligible individuals receive long term care services for aged or physically disabled individuals 80% of these individuals receive services in a home or community based setting 9
11 Oregon s Medicare/ Alignment Proposal Oregon is one of 15 states with a design contract with CMS to develop a demonstration proposal to integrate care for dually eligible individuals Proposal submitted to CMS in May was for capitated financial alignment model, building on CCO model Proposal included passive enrollment with opt-out Long Term Care legislatively excluded from CCOs, proposal included shared accountability approach 10
12 Oregon Decision on Demonstration Oregon has recently decided not to pursue full financial alignment demonstration any further main issue is rates won t work for Oregon, due in part to Oregonspecific factors Instead, Oregon will explore a modified demonstration with CMS, focusing on delivery system reforms underway in CCOs and Medicare/ administrative alignments with no financial component Without a financing model that achieves Medicare savings, we do not expect that CMS would approve passive enrollment into CCOs for Medicare services 11
13 CMS Demonstration Rate-setting Methodology 12
14 Overview of CMS rate-setting methodology Prospective Savings Quality Withhold Separate Part D payment Medicare A/B base rate Savings % taken off rate Medicare Risk Adjustment 1-3 % taken off rate Medicare A/B portion of blended rate base rate Savings % taken off rate Risk Adjustment 1-3 % taken off rate portion of blended rate 13 Based 0n CMS memo, Joint Rate-Setting Process Under the Capitated Financial Alignment Initiative, May Coordination/Medicare-and--Coordination/Medicare--Coordination-Office/Downloads/JointRateSettingProcess.pdf
15 Overview of CMS rate-setting methodology Prospective Savings Quality Withhold Separate Part D payment Medicare A/B base rate Savings % taken off rate Medicare Risk Adjustment 1-3 % taken off rate Medicare A/B portion of blended rate base rate Savings % taken off rate Risk Adjustment 1-3 % taken off rate portion of blended rate Based 0n CMS memo, Joint Rate-Setting Process Under the Capitated Financial Alignment Initiative, May
16 Medicare A/B Base Rate CMS goal: ensure spending under demonstration no higher than would have been in absence of demonstration Medicare Advantage Portion: Historical county-wide bids trended forward and compared to projected benchmarks for each year. Accounts for star bonuses and rebates at county (not plan) level. Medicare FFS Portion: Historical standardized per capita county spending trended forward. CMS will adjust for SGR fix if passed. Blended based on % of enrollees coming from MA vs. FFS 15
17 Overview of CMS rate-setting methodology Prospective Savings Quality Withhold Separate Part D payment Medicare A/B base rate Savings % taken off rate Medicare Risk Adjustment 1-3 % taken off rate Medicare A/B portion of blended rate base rate Savings % taken off rate Risk Adjustment 1-3 % taken off rate portion of blended rate Based 0n CMS memo, Joint Rate-Setting Process Under the Capitated Financial Alignment Initiative, May
18 Base Rate States take lead in developing but CMS must review and approve Managed Care Portion: Historical spending trended forward. FFS Portion: Historical spending trended forward. Blended based on % of enrollees coming from MCOs vs. FFS 17
19 Overview of CMS rate-setting methodology Prospective Savings Quality Withhold Separate Part D payment Medicare A/B base rate Savings % taken off rate Medicare Risk Adjustment 1-3 % taken off rate Medicare A/B portion of blended rate base rate Savings % taken off rate Risk Adjustment 1-3 % taken off rate portion of blended rate Based 0n CMS memo, Joint Rate-Setting Process Under the Capitated Financial Alignment Initiative, May
20 Other aspects of methodology Prospective savings negotiated between state and CMS, same percentage taken out of Medicare and base rates In Massachusetts, 1% in year 1, 2% in year 2, 4% in year 3 Quality withhold same percentage taken out of Medicare and base rates, returned to plans if meet quality requirements/benchmarks 1% in year 1, 2% in year 2, 3% in year 3 Part D payment: National Average Bid Amount plus LIS amount Will not be subject to savings or quality withhold 19
21 Medicare Portion of Rate Problematic in Oregon Oregon FFS costs will continue to be much lower than MA benchmarks 13-16% below benchmarks after account for FFS SGR fix Why? Mechanics of MA rate-setting: New ACA rates leave MA benchmarks at relatively high % of FFS (expect to be 112.5% statewide average in 2014) 2012 average star rating of 3.82 vs. nat l average of 3.49 Estimated 64% of dually eligible individuals living in double bonus counties In blending FFS and MA, high MA penetration mitigates But plans currently serving this population compare demonstration rate to what they are currently getting vs. other states where this is a new market 20
22 Low Medicare FFS Costs in Oregon But why are FFS costs so low in the first place? Low utilization, particularly inpatient Concern that low FFS spending may be partially due to lack of access to care in FFS Medicare 21
23 Next Steps in Oregon Oregon will explore a modified demonstration with CMS, focusing on delivery system reforms underway in CCOs and Medicare/ administrative alignments with no financial component Will also continue to analyze integrated Medicare/ data to better understand the experience of the Medicare FFS population 22
24 23 Questions?
Medicare-Medicaid Alignment Initiative CY 2016 Final Rate Report November 1, 2016
The Illinois Department of Healthcare and Family Services (HFS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the updated Medicare component of the CY 2016 rates
More informationMedicare-Medicaid Alignment Initiative CY 2015 Final Rate Report March 20, 2015
The Illinois Department of Healthcare and Family Services (HFS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the Medicaid and Medicare components of the CY 2015
More informationCal MediConnect CY 2017 Draft Medicare Rate Report May 31, 2016
The State of California, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the preliminary Medicare component of the CY 2017 rates for the California Demonstration
More informationBetter Medicare Alliance Webinar: Medicare Advantage and Part D 2019 Advance Notice and Draft Call Letter. February 8, 2018
Better Medicare Alliance Webinar: Medicare Advantage and Part D 2019 Advance Notice and Draft Call Letter February 8, 2018 RATE NOTICE CRASH Opening COURSE Remarks PAGE http://bettermedicarealliance.org/campaigns
More informationCal MediConnect CY 2014 Rate Report
The State of California, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing draft rates for the California Demonstration to Integrate Care for Dual Eligible Beneficiaries,
More informationExplaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries
P O L I C Y B R I E F kaiser commission on medicaid and the uninsured Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries October 2012 Over the last
More information2016 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS AND BENEFICIARIES
February 6, 2014 GLENN GIESE FSA, MAAA KELLY BACKES FSA, MAAA 2016 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS AND BENEFICIARIES
More informationMedicare Advantage: Program Overview and Recent Experience. James Cosgrove, Ph.D. Director, Health Care U.S. Government Accountability Office
Medicare Advantage: Program Overview and Recent Experience James Cosgrove, Ph.D. Director, Health Care U.S. Government Accountability Office January 15, 2009 01/15/2009 1 In 2008, About 22 Percent of Medicare
More informationNational Health Policy Forum April 28, 2005 Sally Burner CMS
Understanding Medicare Advantage Bidding and Payment: Effects on Plan Choice and Beneficiary Premiums National Health Policy Forum April 28, 2005 Sally Burner CMS MA Bidding and Payment Pre-2006 payment
More information2019 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS
February 6, 2014 GLENN GIESE FSA, MAAA KELLY BACKES FSA, MAAA 2019 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS February
More informationMedicare s different models for caring for beneficiaries with chronic conditions. Mark E. Miller, PhD March 11, 2015
Medicare s different models for caring for beneficiaries with chronic conditions Mark E. Miller, PhD March 11, 2015 Medicare beneficiaries with chronic care needs In 2010, more than two-thirds, or 21.4
More informationkaiser commission on O L I C Y R I E F P H O N E: (202) , F A X: ( 202)
P O L I C Y B R I E F kaiser commission on medicaid and the uninsured October 2012 Massachusetts Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries Executive Summary Massachusetts
More informationCal MediConnect CY 2014 Final Joint Medicare-Medicaid Rate Report October 2017
The State of California (California), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing final calendar year (CY) 2014 rates for the California Demonstration to Integrate
More informationS E C T I O N. Medicare Advantage
S E C T I O N Medicare Advantage Chart 9-1. MA plans available to virtually all Medicare beneficiaries CCPs HMO Any Average plan or local Regional Any MA offerings per PPO PPO CCP PFFS plan county 2009
More informationThe Medicare Advantage program: Status report
C H A P T E R12 The Medicare Advantage program: Status report C H A P T E R 12 The Medicare Advantage program: Status report Chapter summary In this chapter Each year the Commission provides a status
More information79th OREGON LEGISLATIVE ASSEMBLY Regular Session. Enrolled. Senate Bill 934 CHAPTER... AN ACT
79th OREGON LEGISLATIVE ASSEMBLY--2017 Regular Session Enrolled Senate Bill 934 Sponsored by Senator STEINER HAYWARD, Representative BUEHLER CHAPTER... AN ACT Relating to payments for primary care; creating
More informationMedicare Advantage and Part D Reform under the Patient Protection and Affordable Care Act (PPACA)
Medicare Advantage and Part D Reform under the Patient Protection and Affordable Care Act (PPACA) Presented by Matt Chamblee Tampa, FL 813-282-9262 June 16, 2010 Scope of Presentation Medicare Advantage
More informationkaiser medicaid and the uninsured commission on
kaiser commission on medicaid and the uninsured State Demonstrations to Integrate Care and Align Financing for Dual Eligible Beneficiaries: A Review of the 26 Proposals Submitted to CMS October 2012 1330
More informationThe 2018 Advance Notice and Draft Call Letter for Medicare Advantage
The 2018 Advance Notice and Draft Call Letter for Medicare Advantage POLICY PRIMER FEBRUARY 2017 Summary Introduction On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released the
More informationUnderstanding the Bidding Process
Medicare Prescription Drug, Modernization and Improvement Act ( MMA ) Understanding the Bidding Process Presented by William E. Gramlich, Esquire One Logan Square Philadelphia, PA 19103 215-569 569-57395739
More informationstabilize the Medicare Advantage Program
March 4, 2016 The Honorable Sylvia Burwell Secretary, U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Dear Secretary Burwell: The U.S. Chamber of Commerce
More informationThe Advantage of Medicare in Puerto Rico, in Crisis Urgent Action Required. June 9, 2016
The Advantage of Medicare in Puerto Rico, in Crisis Urgent Action Required June 9, 2016 1 Contents 1. The Advantage of Medicare in PR What has MA meant for PR? 2. MA Cliff, MA Crisis, PR Crisis 3. Proposals
More information10/17/2014 Risk-Based Payment Methodologies A National Perspective Art Jones, MD. AccountableCareInstitute.com
10/17/2014 Risk-Based Payment Methodologies A National Perspective Art Jones, MD FQHCs Bridge the Gap in Care Bridge Built and Maintained by FFS Dollars 2 CMMI View of FFS Medicine 3 Accountability High
More informationProvisions of the Medicare Modernization Act
Provisions of the Medicare Modernization Act Medicare Prescription Drug Modernization and Improvement Act of 2003 (MMA) Todd Whitney, FSA, MAAA Wakely Consulting Group Highlights of New Act New Rx Benefit
More informationTRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for April 2007
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for April 2007 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the Kaiser
More informationIntroduction to Medicare Parts C and D
Lippincott Law Firm PLLC Introduction to Medicare Parts C and D Elizabeth Lippincott, Esq. American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues March 20, 2013 Agenda Overview
More informationEstimated Federal Impact of a Proposal to Shift Hospice Spending to Medicare Advantage
To: National Hospice and Palliative Care Organization From: Avalere Health Date: Re: Estimated Federal Impact of a Proposal to Shift Hospice Spending to Medicare Advantage Summary The National Hospice
More informationJanuary 16, Seema Verma Administrator Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244
Seema Verma Administrator Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 RE: CMS-4182-P: Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare
More informationTRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for February 2008
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for February 2008 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the
More informationMedicare Advantage: 2015 National Snapshot
Advantage: 2015 National Snapshot July 2015 Prepared by: Avalere LLC Funding for this research was provided by Aetna. Avalere maintained full editorial control. Advantage: 2015 National Snapshot 1 PROGRAM
More informationTRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for August 2007
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for August 2007 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the
More informationuninsured Medicaid Today; Preparing for Tomorrow A Look at State Medicaid Program Spending, Enrollment and Policy Trends
kaiser commission on medicaid and the uninsured Medicaid Today; Preparing for Tomorrow A Look at State Medicaid Program Spending, Enrollment and Policy Trends Results from a 50-State Medicaid Budget Survey
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Pennsylvania Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
More informationDeep Dive Medicare Advantage Advance Notices Part I and II
Deep Dive Medicare Advantage Advance Notices Part I and II Noah Champagne, FSA, MAAA Noah Champagne is a consulting actuary in Milliman s New York office. Noah has a breadth of Medicare experience working
More informationIssue Brief. What s in the Stars? Quality Ratings of Medicare Advantage Plans, 2010
Issue Brief What s in the Stars? Quality Ratings of Medicare Advantage Plans, 00 December 009 What s in the Stars? Quality Ratings of Medicare Advantage Plans, 00 The Centers for Medicare and Medicaid
More informationMedicare Advantage: 2016 National Snapshot
Medicare Advantage: 2016 National Snapshot Avalere Health LLC May 2016 Avalere Health T 202.207.1300 avalere.com An Inovalon Company F 202.467.4455 1350 Connecticut Ave, NW Washington, DC 20036 Funding
More informationCMS 2016 Call Letter Summary
CMS 2016 Call Letter Summary Annual Calendar (Page 70) combined calendar listing of side-by-side key dates and timelines for operational activities that pertain to Medicare Advantage (MA), Medicare Advantage-
More informationHow is the Affordable Care Act Leading to Changes in Medicaid Today? State Adoption of Five New Options
P O L I C Y B R I E F kaiser commission on medicaid and the uninsured How is the Affordable Care Act Leading to Changes in Medicaid Today? State Adoption of Five New Options May 2012 One primary goal of
More informationJOINT TASK FORCE ON HEALTH CARE COST REVIEW (Senate Bill 419)
May 11 th, 2018 JOINT TASK FORCE ON HEALTH CARE COST REVIEW (Senate Bill 419) 1 AGENDA 8:30-8:35 AM Welcome and Opening Remarks 8:35-9:30 AM Multi-stakeholder Approaches to Address Total Cost of Care 9:35-9:50
More informationMedicare payment policy and its impact on program spending
Medicare payment policy and its impact on program spending James E. Mathews, Ph.D. Deputy Director, Medicare Payment Advisory Commission February 8, 2013 Outline of today s presentation Brief background
More informationMEDICARE ADVANTAGE MA Plans. to $28 per month 46% HOW HEALTH SYSTEMS CAN THRIVE WITH. Developing Your Medicare Advantage Strategy PRODUCT
HOW HEALTH SYSTEMS CAN THRIVE WITH MEDICARE ADVANTAGE The 2019 Medicare Advantage (MA) plan year began on January 1st and once again more Americans enrolled in MA plans than the year before. Fueled by
More informationMEDICARE ADVANTAGE INSIGHTS
Consulting Actuaries Volume 1 FALL 2018 MEDICARE ADVANTAGE INSIGHTS 2019 OPEN ENROLLMENT AND PREPARING FOR 2020 AND BEYOND From October 15, 2018 through December 7, 2018, nearly 60 million seniors and
More informationNOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties
April 3, 2017 NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties SUBJECT: Announcement of Calendar Year (CY) 2018 Medicare Advantage Capitation Rates
More informationMedicaid Redesign Initiatives
Medicaid Redesign Initiatives Dan Heim Executive Vice President LeadingAge New York September 12, 2013 1 Agenda Medicaid Spending/Global Cap MRT Waiver Amendment FIDA Demonstration Balancing Incentive
More informationState of the 2018 Medicare Advantage industry: Stable and growing
State of the 2018 Medicare Advantage industry: February 2018 Julia M. Friedman, FSA, MAAA Brett L. Swanson, FSA, MAAA Table of Contents I. EXECUTIVE SUMMARY... 1 II. BACKGROUND... 3 III. OVERVIEW... 4
More informationModel Design Work Group
Model Design Work Group May 17, 2012 Today s Agenda Procedural status of application Questions on Draft Application HN Design Assumptions/Options Shared Savings Program Design Considerations Co-lead for
More informationSubmitted via Federal e-rule making Portal: April 5, 2019
1 Submitted via Federal e-rule making Portal: http://www.regulations.gov April 5, 2019 Aaron Zajic Office of Inspector General Department of Health and Human Services Cohen Building, Rm 5527 330 Independence
More informationAHCA Managed Care Webinar: Tools for State Executives
AHCA Managed Care Webinar: Tools for State Executives October 29, 2014 AHCA Managed Care Toolkits The Reimbursement & Legal Affairs team is in the process of updating AHCA s Medicaid managed care toolkit
More informationAlternative Strategies for Medicaid Revenue Maximization in Behavioral Health. January 20, 2017
Alternative Strategies for Medicaid Revenue Maximization in Behavioral Health January 20, 2017 Strategies used by states Maximizing federal funds Use the State Plan to maximize the reach of Medicaid 1.
More informationMedicare Advantage (MA) Proposed Benchmark Update and Other Adjustments for CY2020: In Brief
Medicare Advantage (MA) Proposed Benchmark Update and Other Adjustments for CY2020: In Brief February 7, 2019 Congressional Research Service https://crsreports.congress.gov R45494 Contents Introduction...
More informationA Strong Foundation for System Transformation
A Strong Foundation for System Transformation Disabled and Elderly Health Programs Group Center for Medicaid, CHIP and Survey & Certification Centers for Medicare & Medicaid Services April 7, 2011 Top
More informationThe Impact of the Medicare Prescription Drug Benefit on State Programs
The Impact of the Medicare Prescription Drug Benefit on State Programs Molly Maginnis Executive Office of Elder Affairs SHINE Training and Outreach Coordinator Transition to Part D for Duals (Medicare
More informationMedicaid and Managed Care: A National Perspective and Outlook Kansas Health Institute Topeka August 22, 2017
Medicaid and Managed Care: A National Perspective and Outlook Kansas Health Institute Topeka August 22, 2017 Vernon K. Smith, PhD Health Management Associates 2017 Vsmith@HealthManagement.com Medicaid:
More informationFUNDAMENTALS OF MEDICARE PART C TABLE OF CONTENTS
FUNDAMENTALS OF MEDICARE PART C TABLE OF CONTENTS page I. OVERVIEW OF MEDICARE PART C...1 A. ORIGIN... 1 B. KEY CONCEPTS INTRODUCED UNDER THE MEDICARE ADVANTAGE PROGRAM... 2 II. TYPES OF MA PLANS (42 C.F.R.
More informationCHCS. Brief. Technical Assistance
CHCS Center for Health Care Strategies, Inc. Technical Assistance Brief Adapting the Medicare Shared Savings Program to Medicaid Accountable Care Organizations By Rob Houston and Tricia McGinnis, Center
More informationDeveloping Your Value Proposition. Timothy P. McNeill, RN, MPH
Developing Your Value Proposition Timothy P. McNeill, RN, MPH What is a Value Proposition A value proposition is the service or feature that makes an organization attractive to potential customers The
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Colorado Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
More information2018 Medicare Advantage and Part D Rate Announcement and Call Letter, and Request
2018 Medicare Advantage and Part D Rate Announcement and Call Letter, and Request for Information Date 2017-04-03 Title 2018 Medicare Advantage and Part D Rate Announcement and Call Letter, and Request
More informationMedicaid FQHC APMs What are they and what do they mean for health centers? Alex Harris, MSPH Deputy Director, Transformation Policy
Medicaid FQHC APMs What are they and what do they mean for health centers? Alex Harris, MSPH Deputy Director, Transformation Policy aharris@nachc.org What does payment reform look like for health centers?
More informationAre You Optimizing Your Provider-Sponsored Medicare Advantage Plan?
Are You Optimizing Your Provider-Sponsored Medicare Advantage Plan? April 2016 WRITTEN BY: TYRONNE JOLLY, RICH TREMBOWICZ The Medicare market is swelling as the nation s aging population continues to grow.
More informationThe State of Medicare Advantage 2017
The State of Medicare Advantage 2017 Kathryn A. Coleman, Director Medicare Drug & Health Plan Contract Administration Group Center for Medicare Centers for Medicare & Medicaid Services December 2016 1
More informationValue of Medicare Advantage to Low-Income and Minority Medicare Beneficiaries. By: Adam Atherly, Ph.D. and Kenneth E. Thorpe, Ph.D.
Value of Medicare Advantage to Low-Income and Minority Medicare Beneficiaries By: Adam Atherly, Ph.D. and Kenneth E. Thorpe, Ph.D. September 20, 2005 Value of Medicare Advantage to Low-Income and Minority
More informationPRACTICE TRANSFORMATION. Moving Towards A Future of Team Based Care. Michael A. Kolber, PhD, MD
PRACTICE TRANSFORMATION Moving Towards A Future of Team Based Care Michael A. Kolber, PhD, MD 1 2 Financial Disclosures: None Thomas Cole, The Voyage of Life: Childhood 4 Medicare Passed into Law 1965
More informationHIGHLIGHTS OF THE HEALTH REFORM RECONCILIATION BILL AS OF 3/15/2010
HIGHLIGHTS OF THE HEALTH REFORM RECONCILIATION BILL AS OF 3/15/2010 Health Insurance Expansion Makes the tax credits for health insurance premiums more generous for individuals and families with incomes
More informationTechnical Operation Considerations for Implementing Enrollment Periods for States Participating in the Capitated Model Financial Alignment Initiative
Technical Operation Considerations for Implementing Enrollment Periods for States Participating in the Capitated Model Financial Alignment Initiative Presented by: Medicare-Medicaid Coordination Office
More informationFinancial Alignment Demonstrations for Dual Eligible Beneficiaries Compared:
issue brief Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: May 2013, Illinois, Massachusetts, Ohio, and Washington The Centers for Medicare and Medicaid Services (CMS) has
More informationMedicaid Payment and Delivery System Innovation: Minnesota s Experience
Medicaid Payment and Delivery System Innovation: Minnesota s Experience MARIE ZIMMERMAN, MEDICAID DIRECTOR MINNESOTA DEPARTMENT OF HUMAN SERVICES MILBANK RSG 2015 Health Reforms in Minnesota MNSure (state
More informationTRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for October 2008
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for October 2008 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the
More informationMEDICARE PART D PRESCRIPTION DRUG BENEFIT
MEDICARE PART D PRESCRIPTION DRUG BENEFIT On January 21, 2005, the Centers for Medicare & Medicaid Services ( CMS ) issued the final regulations implementing the Medicare prescription drug benefit as well
More information2018 MEDICARE ADVANTAGE RATE PREVIEW
HEALTHCARE SERVICES Managed Care Market Overweight 2018 MEDICARE ADVANTAGE RATE PREVIEW Rates likely to be modestly positive, HIF and Encounter Data biggest "known" moving parts 2018 Advance Notice expected
More informationThe Case For Value ACA to MACRA to MIPS
The Case For Value ACA to MACRA to MIPS 2016-2019 Robert E Nesse M.D. Professor of Family Medicine Mayo Medical School Senior Director of Health Care Policy and Payment Reform nesse.robert@mayo.edu What
More informationEmployer Group Waiver Plans Financial Impact Based on the 2017 Advance Notice Summary
Employer Group Waiver Plans Financial Impact Based on the 2017 Advance Notice Summary Prepared for: U.S. Chamber of Commerce Prepared by: Milliman, Inc. Brett L. Swanson, FSA, MAAA Principal and Consulting
More informationTRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for January 2008
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for January 2008 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the
More informationIssue brief: Medicaid managed care final rule
Issue brief: Medicaid managed care final rule Overview In the past decade, the Medicaid managed care landscape has changed considerably in terms of the number of beneficiaries enrolled in managed care
More informationLessons Learned from the Dual Eligibles Demonstrations. Real-Life Takeaways from the Demonstration States
Lessons Learned from the Dual Eligibles Demonstrations F 1 Real-Life Takeaways from the Demonstration States Who Are the Dual Eligibles? Dual Eligibles by Eligibility Pathway, 20 Dual Eligibles include
More informationA Guide to Medicare s s Financial Challenges and Options for Improvement
A Guide to Medicare s s Financial Challenges and Options for Improvement December 12, 2011 December 2011 Notes for speakers: Presentation of the full slide deck will take approximately 25 to 30 minutes,
More informationCMS Releases Proposed Rule on Medicare Advantage and Medicare Prescription Drug Plan MLR Requirements. Jacinta L. Alves
CMS Releases Proposed Rule on Medicare Advantage and Medicare Prescription Drug Plan MLR Requirements Jacinta L. Alves Background: What is an MLR?» MLR stands for Medical Loss Ratio.» An MLR is expressed
More informationUtilizing Predictive Models to Target for Clinical and Diagnosis Gaps. Predictive Modeling Summit September 16, 2016 Presented by Scott Weiner
Utilizing Predictive Models to Target for Clinical and Diagnosis Gaps Predictive Modeling Summit September 16, 2016 Presented by Scott Weiner Agenda Who is EMSI? Risk Adjustment Primer Historical Predictive
More informationProviding Meaningful Oversight of Risk Adjustment Programs. February 1, 2016
Providing Meaningful Oversight of Risk Adjustment Programs February 1, 2016 Presented by: Richard Lieberman Chief Data Scientist TODAY S AGENDA A brief history of Medicare-Advantage rate-setting and risk
More informationAmerican Dental Association Changing Payment System. Medicare Coverage Addendum
Tax American Dental Association Changing Payment System Medicare Coverage Addendum Contents of Benefit Implementation Strategies 3 Medicare 10 Medicare 15 21 was engaged to perform actuarial services.
More informationLEGAL CONCERNS FOR POLIO SURVIVORS:
LEGAL CONCERNS FOR POLIO SURVIVORS: A Benefits Primer with an emphasis on Medicare and the Affordable Care Act Martha C. Brown Martha C. Brown & Associates, LLC 220 W. Lockwood, Suite 203 ST. Louis, MO
More informationOne-Third of Medicaid Spending is for Long Term Services and Supports
Why States Are Moving to Medicaid Managed Long-Term Services and Supports (MLTSS) NCSL Fall Forum December 3, 2013 Brian Burwell, Truven Health Analytics One-Third of Medicaid Spending is for Long Term
More informationTHE OKLAHOMA HEALTH CARE AUTHORITY
HEALTH WEALTH CAREER THE OKLAHOMA HEALTH CARE AUTHORITY SOONERHEALTH+ DRAFT/MODELED CAPITATION RATE DEVELOPMENT & DATA BOOK FEBRUARY 11 2015 ACTUARIAL BIDDERS CONFERENCE FEBRUARY 1, 2017 Presenter: Mike
More informationImplementing the Alternative Benefit Plan
Implementing the Alternative Benefit Plan Carolyn Ingram, Senior Vice President Shannon McMahon, Director of Coverage and Access State Network Medicaid Small Group Convening April 25, 2013 Agenda Alternative
More informationTRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for October 2006
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for October 2006 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the
More informationTRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for October 2007
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for October 2007 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the
More informationNorth Carolina Medical Society 2015 Medicaid Reform Analysis Updated 07/15/15
Section 2: (5) Provider-led entity. Any of the following: a. A provider. b. An entity with the primary purpose of owning or operating one or more providers. c. A business entity in which providers hold
More informationWhat Every Actuary Should Know About Medicare From Structure to Reform
What Every Actuary Should Know About Medicare From Structure to Reform Cori E. Uccello, FSA, MAAA, MPP Senior Health Fellow, American Academy of Actuaries Thomas F. Wildsmith, FSA, MAAA Vice President
More informationProjected Savings of Medicaid Capitated Care: National and State-by-State. October 2015
Projected Savings of Medicaid Capitated Care: National and State-by-State October 2015 I. Executive Summary We were asked by the Association for Community Affiliated Plans (ACAP) to estimate the Medicaid
More informationMedicaid Alternative Benefit Plans and Essential Health Benefits 9/10/13
Medicaid Alternative Benefit Plans and Essential Health Benefits 9/10/13 Melissa Harris, Division Director Division of Benefits and Coverage Disabled and Elderly Health Programs Group Background Intended
More informationTransforming Medicare into a Premium Support System: Implications for Beneficiary Premiums 1
Transforming Medicare into a Premium Support System: Implications for Beneficiary Premiums EXECUTIVE SUMMARY Over the past several decades, the idea of transforming Medicare from its current structure
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Arkansas Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
More informationMEDICARE ADVANTAGE IN RURAL AREAS: EXPERIENCE UNDER THE MMA
MEDICARE ADVANTAGE IN RURAL AREAS: EXPERIENCE UNDER THE MMA by Marsha Gold, Sc.D. Senior Fellow Mathematica Policy Research October 10, 2007 For presentation at a briefing for the Senate Finance Committee
More informationFrom Gang Members to Healthcare. Federal Landscape. Health Care Reform & Deficit Reduction
From Gang Members to Healthcare California Medical Reform Association Federal Landscape Health Care Reform & Deficit Reduction Elizabeth McNeil Vice President Federal Government Relations STATUS OF HEALTH
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile New York Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
More informationComparing Traditional Medicare to Medicare Advantage
Comparing Traditional Medicare to Medicare Advantage Amil Petrin University of Minnesota-Twin Cities and Heller Hurwicz Economics Institute November 17, 2016 Amil Petrin (University of Minnesota-Twin Comparing
More informationLetter From The Puerto Rico Healthcare Community
Letter From The Puerto Rico Healthcare Community September 6, 2016 VIA REGULATIONS.GOV FILING Andrew M. Slavitt Acting Administrator, Centers for Medicare & Medicaid Services Department of Health and Human
More informationProposed Rule on Medicaid Managed Care: A Summary of Major Provisions
Proposed Rule on Medicaid Managed Care: A Summary of Major Provisions Julia Paradise and MaryBeth Musumeci On June 1, 2015, the Centers for Medicare & Medicaid Services (CMS) published a Notice of Proposed
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile South Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More information2019 MEDICARE ADVANTAGE RATE PREVIEW
HEALTHCARE SERVICES Managed Care Market Overweight 2019 MEDICARE ADVANTAGE RATE PREVIEW 2019 Rate Environment Sets up Positively for MCOs 2019 Advance Notice Expected Imminently Part 2 of the 2019 Medicare
More information